1. Dogac, Kabak, YukselOASIS SET TC Working Document The Use of CCTS in HL7 CDA Asuman Dogac, Yildiray Kabak, Mustafa Yuksel METU, Ankara, Turkey

2. Dogac, Kabak, Yuksel OASIS SET TC Working Document HL7 CDA The HL7 Clinical Document Architecture (CDA) is a document markup standard that specifies the structure and semantics of "clinical documents" for the purpose of exchange CDA documents derive their machine processable meaning from the HL7 Reference Information Model (RIM) and use the HL7 Version 3 Data Types They are encoded in Extensible Markup Language (XML)

3. Dogac, Kabak, Yuksel OASIS SET TC Working Document 4/12/20153 Main Components of a CDA Document A CDA document is wrapped by the element, and contains a header and a body The header lies between the and the elements, and provides information on authentication, the encounter, the patient, and the involved providers

4. Dogac, Kabak, Yuksel OASIS SET TC Working Document Main Components of a CDA Document The body contains the clinical report, and can be either an unstructured blob, or can be comprised of structured markup A CDA document section is wrapped by the element Each section can contain a single narrative block, and any number of CDA entries and external references

5. Dogac, Kabak, Yuksel OASIS SET TC Working Document 4/12/20155 Major Components of a CDA Document CDA entries represent structured content provided for further computer processing (e.g. decision support applications)

6. Dogac, Kabak, Yuksel OASIS SET TC Working Document HL7 CDA Interoperability HL7 CDA helps with interoperability through  Structured body  Coded elements  HL7 Data Types  CDA Entry classes: RIM Act, Observation, SubstanceAdministration, Supply, Encounter, Procedure, ObservationMedia, Organizer, RegionOfInterest But  CDA Documents can have any structure by nesting the sections at any depth and in any way  There can be data elements that are not defined for CDA but are necessary for local implementations such as Vaccination, Discharge Method (referral, death or cured), Type of Contagiousness, …  There is a need for expressing the CDA concepts in local languages

7. Dogac, Kabak, Yuksel OASIS SET TC Working Document To Enhance CDA Interoperability… Start from UN/CEFACT CCTS  Define BCCs Reuse existing HL7 Data Types and Data Elements Define the missing data elements by constraining relevant RIM classes  Define ACCs Use BCCs to define minimum health data sets Hence create a local (or national) data dictionary It will be much better if HL7 defines these constructs and the countries customize these according to their context

8. Dogac, Kabak, Yuksel OASIS SET TC Working Document Building a National Data Dictionary For Creating CDAs Building a local or national common data dictionary consisting of data elements (BCCs) and minimum health data sets (ACCs) will  Clearly define the meaning of data elements  Give their corresponding explanation in the local language  Create the additional data elements needed locally from the corresponding RIM Classes  Also note that defining minimum health data sets as Aggregate Core Components will determine their structure and semantics All these will help with the interoperability of CDAs

9. Dogac, Kabak, Yuksel OASIS SET TC Working Document Data Types in HL7 http://hl7.org/v3ballot/html/infrastructure/datatypes/datatypes.htm The Data Types in HL7 constitutes the Qualified Data Types Define your BCCs using already defined data elements in HL7, e.g., “houseNumber” Define your ACCs based on the data elements defined in HL7, e.g., “addr”

10. Dogac, Kabak, Yuksel OASIS SET TC Working Document Creating the Missing Data Elements by Constraining RIM Classes RIM Class ACT SubstanceAdministration - code - effectiveTime Assume you need a “Vaccination” Data Element (ACC) with the following properties (BCCs): Type of Vaccination Date of application

11. Dogac, Kabak, Yuksel OASIS SET TC Working Document Creating the Minimum Health Datasets by Constraining RIM Classes: An Example Then you need a “Vaccination” minimum data set (A bigger ACC) Lot number of the vaccination Organization Professional Identifier General Practitioner RIM Class Entity Organization - Addr (BCC) RIM Class Entity (ACC) ManufacturedMaterial - lotNumberText (BCC) RIM Class Entity Person (ACC) - Id (BCC) RIM Class Entity Person (ACC) - Id (BCC) Role Physician (ACC) Role Physician (ACC) Role HealthcareProvider (ACC) Role therapeutic agent (ACC) Performerresponsible party Location consumable Participation (ASCC) Played Entity (ASCC)

12. Dogac, Kabak, Yuksel OASIS SET TC Working Document Mapping the Minimum Datasets to the CDA Sections There is not a unique way of doing this  !

13. Dogac, Kabak, Yuksel OASIS SET TC Working Document An Example Mapping Minimum Health Datasets to CDA Sections and Entities CDA HEADER BODY Section Code: Vaccine Section Code: consumable Code: responsible party Entry Code: Role Entry Code: lotNumberText Value: 123456 Value: Therapeutic Agent Entry Code: Entity Value: Manufactured Material Entry Code: Role Entry Code: id Value: 789123 Value: Physician Entry Code: Entity Value: Person author custodian Component

14. Dogac, Kabak, Yuksel OASIS SET TC Working Document Another Example Mapping Minimum Health Datasets to CDA Sections and Entities CDA HEADER BODY Section Code: Vaccine Observation Code: Vaccination Participant typeCode: Responsible Party playingEntity participantRole classCode: Physician author custodian classCode: Person id: 789123 Participant typeCode: Consumable playingDevice participantRole classCode: Therapeutic agent classCode: Manufactured Material code: 123456 Participation 1 Participation 2 Entry

15. Dogac, Kabak, Yuksel OASIS SET TC Working Document Increasing CDA Interoperability… However, when CCTS Approach is used in forming the CDAs, the document components are well defined Hence, SET TC specifications can be used to map different CDA documents These are just the initial ideas

16. Dogac, Kabak, YukselOASIS SET TC Working Document Thank you for your attention